Individual
DR. JON GABRIEL ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7777 ALVARADO RD STE 108, LA MESA, CA 91942-8245
(619) 460-2774
(619) 460-2774
Mailing address
7777 ALVARADO RD STE 108, LA MESA, CA 91942-8245
(619) 460-2774
(619) 460-2774
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
125049476
IL
Other
Enumeration date
09/04/2008
Last updated
03/02/2012
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